﻿<div id="reg-box-step-1" class="grid_8  p-r z-i-0 p-20 ">
    <div class="p-a t-0 l-0 b-0 r-0 tranf-w-50 d-p-n" style="z-index: 1001"></div>
    <div class="p-a t-0 l-0 b-0 r-0 b-g-ldg b-g-c-w _overflow" style="z-index: 1002"></div>
    <form id="_frm" name="_frm" action="{{"widgets/ei"|base_url}}" method="POST" 
          onsubmit="return _sm_reg();return false;" 
          target="integration_asynchronous" autocomplete="off" >
        <!--      name      -->
        <div class="p-r p-b-12">
            <p><label class="d-p-b w-i" for="_name"> Họ và tên</label></p>
            <input 
                type="text" 
                class=" b-g-c-i w-i validate[required,minSize[2],maxSize[30]]" 
                value="Khương Xuân Trường" 
                minlength="2"
                maxlength="30" 
                id="_name" name="_name"
                />
        </div>
        <div class="clear"></div>
        <!--      email      -->
        <div class="p-r p-b-12">
            <p><label class="d-p-b w-i" for="_mail"> Email</label></p>
            <input 
                type="text" 
                class="w-i b-g-c-i validate[required,custom[email],maxSize[80]]" 
                data-errormessage-value-missing="Email không được để trống!" 
                data-errormessage-custom-error="Email không hợp lệ, gợi ý : someone@any.com" 
                data-errormessage="This is the fall-back error message."
                value="khuongxuantruong@gmail.com"
                placeholder="@mailtype.com"
                maxlength="80" 
                id="_mail" name="_mail"
                />
        </div>
        <div class="clear"></div>
        <!--      pass      -->
        <div class="p-r p-b-12">
            <p><label class="d-p-b w-i" for="_password">Mật khẩu</label></p>
            <div class="p-r">
                <input type="password" 
                       class="w-i b-g-c-i validate[required,minSize[6],maxSize[30]]" 
                       minlength="6"
                       maxlength="30"
                       value="123abcABC" 
                       id="_password" name="_password"
                       onfocus="$('#passwordstrength').show()"
                       onblur="$('#passwordstrength').hide()"
                       />
                <div id="passwordstrength" class="jfk-bubble jfk-bubble-promo d-p-n" 
                     style="visibility: visible;opacity: 1;top:-8px;left: 332px;">
                    <div class="jfk-bubble-content">
                        <div class="password-strength">
                            <p>
                                <strong>Password strength:</strong>
                                <span id="passwdRating">Too short</span>
                            </p>
                            <div class="meter" id="passwdBar" style="background: #ccc;">
                                <span id="strength-bar" class="strong" 
                                      style="width: 2px;display: block;background: red;height: 4px"></span>
                            </div>
                        </div>
                        <div>
                            Use at least 6 characters. 
                            Don’t use a password from another site, 
                            or something too obvious like your pet’s name. 
                            <a id="PasswdLink" target="_blank" href="">Why?</a>
                        </div>
                    </div>
                    <div class="jfk-bubble-arrow-id jfk-bubble-arrow jfk-bubble-arrowleft" style="top: 20px;">
                        <div class="jfk-bubble-arrowimplbefore"></div>
                        <div class="jfk-bubble-arrowimplafter"></div>
                    </div>
                </div>
            </div>
        </div>
        <div class="clear"></div>
        <!--      repass      -->
        <div class="p-r p-b-12">
            <label for="_repassword"><p>Xác nhận mật khẩu</p></label>
            <input 
                type="password" 
                class="w-i b-g-c-i validate[required,equals[_password]]" 
                value="123abcABC" 
                minlength="6"
                maxlength="30"
                placeholder="Password" 
                id="_repassword" name="_repassword"

                />

        </div>
        <div class="clear"></div>
        <!--      lang social      -->
        <div class="p-r p-b-12 f-l">
            <div class="w-160 f-l">
                <div class="p-r-2">
                    <!--      lang      -->
                    <div class="p-r">
                        <p>Ngôn ngữ</p>
                        <div class="p-r">
                            <select class="w-i p-a t-0 l-0 validate[required]" id="_lang" multiple="true" size="1">
                                <option value="">Choose a language</option>
                                <option value="af">‪Afrikaans‬</option>
                                <option value="ms">‪Bahasa Melayu‬</option>
                                <option value="ca">‪Català‬</option>
                                <option value="cs">‪Čeština‬</option>
                                <option value="da">‪Dansk‬</option>
                                <option value="de">‪Deutsch‬</option>
                                <option value="et">‪Eesti‬</option>
                                <option value="en_GB">‪English (United Kingdom)‬</option>
                                <option value="en">‪English (United States)‬</option>
                                <option value="es">‪Español (España)‬</option>
                                <option value="es_419">‪Español (Latinoamérica)‬</option>
                                <option value="tl">‪Filipino‬</option>
                                <option value="fr">‪Français‬</option>
                                <option value="hr">‪Hrvatski‬</option>
                                <option value="zu">‪IsiZulu‬</option>
                                <option value="it">‪Italiano‬</option>
                                <option value="sw">‪Kiswahili‬</option>
                                <option value="lv">‪Latviešu‬</option>
                                <option value="lt">‪Lietuvių‬</option>
                                <option value="hu">‪Magyar‬</option>
                                <option value="nl">‪Nederlands‬</option>
                                <option value="no">‪Norsk‬</option>
                                <option value="pl">‪Polski‬</option>
                                <option value="pt_BR">‪Português (Brasil)‬</option>
                                <option value="pt_PT">‪Português (Portugal)‬</option>
                                <option value="ro">‪Română‬</option>
                                <option value="sk">‪Slovenčina‬</option>
                                <option value="sl">‪Slovenščina‬</option>
                                <option value="fi">‪Suomi‬</option>
                                <option value="sv">‪Svenska‬</option>
                                <option value="vi" selected="1">‪Tiếng Việt‬</option>
                                <option value="tr">‪Türkçe‬</option>
                                <option value="el">‪Ελληνικά‬</option>
                                <option value="be">‪Беларуская‬</option>
                                <option value="bg">‪Български‬</option>
                                <option value="ru">‪Русский‬</option>
                                <option value="sr">‪Српски‬</option>
                                <option value="uk">‪Українська‬</option>
                                <option value="am">‪አማርኛ‬</option>
                                <option value="hi">‪हिन्दी‬</option>
                                <option value="th">‪ไทย‬</option>
                                <option value="ko">‪한국어‬</option>
                                <option value="ja">‪日本語‬</option>
                                <option value="zh_CN">‪简体中文‬</option>
                                <option value="zh_TW">‪繁體中文‬</option>
                            </select>
                        </div>
                    </div>
                </div>
            </div>
            <div class="w-160 f-l">
                <div class="p-l-2">
                    <!--      social      -->
                    <div class="p-r">
                        <p>Xã hội</p>
                        <div class="p-r">
                            <select id="_sgn_type" class="w-i p-a t-0 l-0 validate[required]" multiple="true" size="1">
                                <option value="option1" selected="1">Google</option>
                                <option value="option2">Yahoo !</option>
                                <option value="option3">Facebook</option>
                                <option value="option4">Zing Me</option>
                                <option value="option5">Youtube</option>
                                <option value="option6">MySpave</option>
                                <option value="option7">Pinterest</option>
                            </select>
                        </div>
                    </div>
                </div>
            </div>
            <p class="erc d-p-n">Hmm, the day doesn't look right. Be sure to use a 2-digit number that is a day of the month.</p>
        </div>
        <div class="clear"></div>
        <div class="p-r p-b-12 f-l">
            <div class="w-160 f-l">
                <!--      birth      -->
                <div class="p-r-2">
                    <div class="p-r">
                        <p>Ngày sinh</p>
                        <div class="p-r">
                            <select id="_sgn_month" class="w-i p-a t-0 l-0 validate[required]" multiple="true" size="1">
                                <option value="01">January</option>
                                <option value="02">February</option>
                                <option value="03">March</option>
                                <option value="04">April</option>
                                <option value="05">May</option>
                                <option value="06">June</option>
                                <option value="07">July</option>
                                <option value="08">August</option>
                                <option value="09" selected="1">September</option>
                                <option value="10">October</option>
                                <option value="11">November</option>
                                <option value="12">December</option>
                            </select>
                        </div>
                    </div>
                </div>
            </div>
            <div class="w-160 f-l">
                <!--      year      -->
                <div class="p-l-2">
                    <div class="p-r">
                        <p>&nbsp;</p>
                        <input type="text" 
                               class="w-i f-l b-g-c-i validate[required,custom[onlyNumberSp]]" 
                               value="1987" 
                               id="_year" 
                               name="_year" 
                               placeholder="Năm"/>
                    </div>
                </div>
            </div>
        </div>
        <div class="clear"></div>
        <!--      region      -->
        <div class="p-r p-b-12">
            <p>Quốc gia</p>
            <div class="p-r">
                <select id="_mul_contr" name="_mul_contr" class="w-i p-a t-0 l-0 validate[required]" multiple="true" size="1"> 
                    <option value="United States">United States</option> 
                    <option value="United Kingdom">United Kingdom</option> 
                    <option value="Afghanistan">Afghanistan</option> 
                    <option value="Albania">Albania</option> 
                    <option value="Algeria">Algeria</option> 
                    <option value="American Samoa">American Samoa</option> 
                    <option value="Andorra">Andorra</option> 
                    <option value="Angola">Angola</option> 
                    <option value="Anguilla">Anguilla</option> 
                    <option value="Antarctica">Antarctica</option> 
                    <option value="Antigua and Barbuda">Antigua and Barbuda</option> 
                    <option value="Argentina">Argentina</option> 
                    <option value="Armenia">Armenia</option> 
                    <option value="Aruba">Aruba</option> 
                    <option value="Australia">Australia</option> 
                    <option value="Austria">Austria</option> 
                    <option value="Azerbaijan">Azerbaijan</option> 
                    <option value="Bahamas">Bahamas</option> 
                    <option value="Bahrain">Bahrain</option> 
                    <option value="Bangladesh">Bangladesh</option> 
                    <option value="Barbados">Barbados</option> 
                    <option value="Belarus">Belarus</option> 
                    <option value="Belgium">Belgium</option> 
                    <option value="Belize">Belize</option> 
                    <option value="Benin">Benin</option> 
                    <option value="Bermuda">Bermuda</option> 
                    <option value="Bhutan">Bhutan</option> 
                    <option value="Bolivia">Bolivia</option> 
                    <option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option> 
                    <option value="Botswana">Botswana</option> 
                    <option value="Bouvet Island">Bouvet Island</option> 
                    <option value="Brazil">Brazil</option> 
                    <option value="British Indian Ocean Territory">British Indian Ocean Territory</option> 
                    <option value="Brunei Darussalam">Brunei Darussalam</option> 
                    <option value="Bulgaria">Bulgaria</option> 
                    <option value="Burkina Faso">Burkina Faso</option> 
                    <option value="Burundi">Burundi</option> 
                    <option value="Cambodia">Cambodia</option> 
                    <option value="Cameroon">Cameroon</option> 
                    <option value="Canada">Canada</option> 
                    <option value="Cape Verde">Cape Verde</option> 
                    <option value="Cayman Islands">Cayman Islands</option> 
                    <option value="Central African Republic">Central African Republic</option> 
                    <option value="Chad">Chad</option> 
                    <option value="Chile">Chile</option> 
                    <option value="China">China</option> 
                    <option value="Christmas Island">Christmas Island</option> 
                    <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option> 
                    <option value="Colombia">Colombia</option> 
                    <option value="Comoros">Comoros</option> 
                    <option value="Congo">Congo</option> 
                    <option value="Congo, The Democratic Republic of The">Congo, The Democratic Republic of The</option> 
                    <option value="Cook Islands">Cook Islands</option> 
                    <option value="Costa Rica">Costa Rica</option> 
                    <option value="Cote D'ivoire">Cote D'ivoire</option> 
                    <option value="Croatia">Croatia</option> 
                    <option value="Cuba">Cuba</option> 
                    <option value="Cyprus">Cyprus</option> 
                    <option value="Czech Republic">Czech Republic</option> 
                    <option value="Denmark">Denmark</option> 
                    <option value="Djibouti">Djibouti</option> 
                    <option value="Dominica">Dominica</option> 
                    <option value="Dominican Republic">Dominican Republic</option> 
                    <option value="Ecuador">Ecuador</option> 
                    <option value="Egypt">Egypt</option> 
                    <option value="El Salvador">El Salvador</option> 
                    <option value="Equatorial Guinea">Equatorial Guinea</option> 
                    <option value="Eritrea">Eritrea</option> 
                    <option value="Estonia">Estonia</option> 
                    <option value="Ethiopia">Ethiopia</option> 
                    <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option> 
                    <option value="Faroe Islands">Faroe Islands</option> 
                    <option value="Fiji">Fiji</option> 
                    <option value="Finland">Finland</option> 
                    <option value="France">France</option> 
                    <option value="French Guiana">French Guiana</option> 
                    <option value="French Polynesia">French Polynesia</option> 
                    <option value="French Southern Territories">French Southern Territories</option> 
                    <option value="Gabon">Gabon</option> 
                    <option value="Gambia">Gambia</option> 
                    <option value="Georgia">Georgia</option> 
                    <option value="Germany">Germany</option> 
                    <option value="Ghana">Ghana</option> 
                    <option value="Gibraltar">Gibraltar</option> 
                    <option value="Greece">Greece</option> 
                    <option value="Greenland">Greenland</option> 
                    <option value="Grenada">Grenada</option> 
                    <option value="Guadeloupe">Guadeloupe</option> 
                    <option value="Guam">Guam</option> 
                    <option value="Guatemala">Guatemala</option> 
                    <option value="Guinea">Guinea</option> 
                    <option value="Guinea-bissau">Guinea-bissau</option> 
                    <option value="Guyana">Guyana</option> 
                    <option value="Haiti">Haiti</option> 
                    <option value="Heard Island and Mcdonald Islands">Heard Island and Mcdonald Islands</option> 
                    <option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option> 
                    <option value="Honduras">Honduras</option> 
                    <option value="Hong Kong">Hong Kong</option> 
                    <option value="Hungary">Hungary</option> 
                    <option value="Iceland">Iceland</option> 
                    <option value="India">India</option> 
                    <option value="Indonesia">Indonesia</option> 
                    <option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option> 
                    <option value="Iraq">Iraq</option> 
                    <option value="Ireland">Ireland</option> 
                    <option value="Israel">Israel</option> 
                    <option value="Italy">Italy</option> 
                    <option value="Jamaica">Jamaica</option> 
                    <option value="Japan">Japan</option> 
                    <option value="Jordan">Jordan</option> 
                    <option value="Kazakhstan">Kazakhstan</option> 
                    <option value="Kenya">Kenya</option> 
                    <option value="Kiribati">Kiribati</option> 
                    <option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option> 
                    <option value="Korea, Republic of">Korea, Republic of</option> 
                    <option value="Kuwait">Kuwait</option> 
                    <option value="Kyrgyzstan">Kyrgyzstan</option> 
                    <option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option> 
                    <option value="Latvia">Latvia</option> 
                    <option value="Lebanon">Lebanon</option> 
                    <option value="Lesotho">Lesotho</option> 
                    <option value="Liberia">Liberia</option> 
                    <option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya</option> 
                    <option value="Liechtenstein">Liechtenstein</option> 
                    <option value="Lithuania">Lithuania</option> 
                    <option value="Luxembourg">Luxembourg</option> 
                    <option value="Macao">Macao</option> 
                    <option value="Macedonia, The Former Yugoslav Republic of">Macedonia, The Former Yugoslav Republic of</option> 
                    <option value="Madagascar">Madagascar</option> 
                    <option value="Malawi">Malawi</option> 
                    <option value="Malaysia">Malaysia</option> 
                    <option value="Maldives">Maldives</option> 
                    <option value="Mali">Mali</option> 
                    <option value="Malta">Malta</option> 
                    <option value="Marshall Islands">Marshall Islands</option> 
                    <option value="Martinique">Martinique</option> 
                    <option value="Mauritania">Mauritania</option> 
                    <option value="Mauritius">Mauritius</option> 
                    <option value="Mayotte">Mayotte</option> 
                    <option value="Mexico">Mexico</option> 
                    <option value="Micronesia, Federated States of">Micronesia, Federated States of</option> 
                    <option value="Moldova, Republic of">Moldova, Republic of</option> 
                    <option value="Monaco">Monaco</option> 
                    <option value="Mongolia">Mongolia</option> 
                    <option value="Montserrat">Montserrat</option> 
                    <option value="Morocco">Morocco</option> 
                    <option value="Mozambique">Mozambique</option> 
                    <option value="Myanmar">Myanmar</option> 
                    <option value="Namibia">Namibia</option> 
                    <option value="Nauru">Nauru</option> 
                    <option value="Nepal">Nepal</option> 
                    <option value="Netherlands">Netherlands</option> 
                    <option value="Netherlands Antilles">Netherlands Antilles</option> 
                    <option value="New Caledonia">New Caledonia</option> 
                    <option value="New Zealand">New Zealand</option> 
                    <option value="Nicaragua">Nicaragua</option> 
                    <option value="Niger">Niger</option> 
                    <option value="Nigeria">Nigeria</option> 
                    <option value="Niue">Niue</option> 
                    <option value="Norfolk Island">Norfolk Island</option> 
                    <option value="Northern Mariana Islands">Northern Mariana Islands</option> 
                    <option value="Norway">Norway</option> 
                    <option value="Oman">Oman</option> 
                    <option value="Pakistan">Pakistan</option> 
                    <option value="Palau">Palau</option> 
                    <option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option> 
                    <option value="Panama">Panama</option> 
                    <option value="Papua New Guinea">Papua New Guinea</option> 
                    <option value="Paraguay">Paraguay</option> 
                    <option value="Peru">Peru</option> 
                    <option value="Philippines">Philippines</option> 
                    <option value="Pitcairn">Pitcairn</option> 
                    <option value="Poland">Poland</option> 
                    <option value="Portugal">Portugal</option> 
                    <option value="Puerto Rico">Puerto Rico</option> 
                    <option value="Qatar">Qatar</option> 
                    <option value="Reunion">Reunion</option> 
                    <option value="Romania">Romania</option> 
                    <option value="Russian Federation">Russian Federation</option> 
                    <option value="Rwanda">Rwanda</option> 
                    <option value="Saint Helena">Saint Helena</option> 
                    <option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option> 
                    <option value="Saint Lucia">Saint Lucia</option> 
                    <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option> 
                    <option value="Saint Vincent and The Grenadines">Saint Vincent and The Grenadines</option> 
                    <option value="Samoa">Samoa</option> 
                    <option value="San Marino">San Marino</option> 
                    <option value="Sao Tome and Principe">Sao Tome and Principe</option> 
                    <option value="Saudi Arabia">Saudi Arabia</option> 
                    <option value="Senegal">Senegal</option> 
                    <option value="Serbia and Montenegro">Serbia and Montenegro</option> 
                    <option value="Seychelles">Seychelles</option> 
                    <option value="Sierra Leone">Sierra Leone</option> 
                    <option value="Singapore">Singapore</option> 
                    <option value="Slovakia">Slovakia</option> 
                    <option value="Slovenia">Slovenia</option> 
                    <option value="Solomon Islands">Solomon Islands</option> 
                    <option value="Somalia">Somalia</option> 
                    <option value="South Africa">South Africa</option> 
                    <option value="South Georgia and The South Sandwich Islands">South Georgia and The South Sandwich Islands</option> 
                    <option value="Spain">Spain</option> 
                    <option value="Sri Lanka">Sri Lanka</option> 
                    <option value="Sudan">Sudan</option> 
                    <option value="Suriname">Suriname</option> 
                    <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option> 
                    <option value="Swaziland">Swaziland</option> 
                    <option value="Sweden">Sweden</option> 
                    <option value="Switzerland">Switzerland</option> 
                    <option value="Syrian Arab Republic">Syrian Arab Republic</option> 
                    <option value="Taiwan, Province of China">Taiwan, Province of China</option> 
                    <option value="Tajikistan">Tajikistan</option> 
                    <option value="Tanzania, United Republic of">Tanzania, United Republic of</option> 
                    <option value="Thailand">Thailand</option> 
                    <option value="Timor-leste">Timor-leste</option> 
                    <option value="Togo">Togo</option> 
                    <option value="Tokelau">Tokelau</option> 
                    <option value="Tonga">Tonga</option> 
                    <option value="Trinidad and Tobago">Trinidad and Tobago</option> 
                    <option value="Tunisia">Tunisia</option> 
                    <option value="Turkey">Turkey</option> 
                    <option value="Turkmenistan">Turkmenistan</option> 
                    <option value="Turks and Caicos Islands">Turks and Caicos Islands</option> 
                    <option value="Tuvalu">Tuvalu</option> 
                    <option value="Uganda">Uganda</option> 
                    <option value="Ukraine">Ukraine</option> 
                    <option value="United Arab Emirates">United Arab Emirates</option> 
                    <option value="United Kingdom">United Kingdom</option> 
                    <option value="United States">United States</option> 
                    <option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option> 
                    <option value="Uruguay">Uruguay</option> 
                    <option value="Uzbekistan">Uzbekistan</option> 
                    <option value="Vanuatu">Vanuatu</option> 
                    <option value="Venezuela">Venezuela</option> 
                    <option value="Viet Nam" selected="1">Viet Nam</option> 
                    <option value="Virgin Islands, British">Virgin Islands, British</option> 
                    <option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option> 
                    <option value="Wallis and Futuna">Wallis and Futuna</option> 
                    <option value="Western Sahara">Western Sahara</option> 
                    <option value="Yemen">Yemen</option> 
                    <option value="Zambia">Zambia</option> 
                    <option value="Zimbabwe">Zimbabwe</option>
                </select>
            </div>
            <p class="erc"></p>
        </div>
        <div class="clear"></div>
        <!--      quest      -->
        <div class="p-r p-b-12">
            <p><label class="d-p-b w-i" for="_brd">Câu hỏi bảo mật</label></p>
            <div class="p-r">
                <select id="_sgn_qst" class="w-i p-a t-0 l-0 validate[required]" multiple="true" size="1">
                    <option selected="1">What was your childhood nickname? </option>
                    <option>In what city did you meet your spouse/significant other?</option>
                    <option>What is the name of your favorite childhood friend? </option>
                    <option>What street did you live on in third grade?</option>
                    <option>What is your oldest sibling’s birthday month and year? (e.g., January 1900) </option>
                    <option>What is the middle name of your oldest child?</option>
                    <option>What is your oldest sibling's middle name?</option>
                    <option>What school did you attend for sixth grade?</option>
                    <option>What was your childhood phone number including area code? (e.g., 000-000-0000)</option>
                    <option>What is your oldest cousin's first and last name?</option>
                    <option>What was the name of your first stuffed animal?</option>
                    <option>In what city or town did your mother and father meet? </option>
                    <option>Where were you when you had your first kiss? </option>
                    <option>What is the first name of the boy or girl that you first kissed?</option>
                    <option>What was the last name of your third grade teacher?</option>
                    <option>In what city does your nearest sibling live? </option>
                    <option>What is your oldest brother’s birthday month and year? (e.g., January 1900) </option>
                    <option>What is your maternal grandmother's maiden name?</option>
                    <option>In what city or town was your first job?</option>
                    <option>What is the name of the place your wedding reception was held?</option>
                    <option>What is the name of a college you applied to but didn't attend?</option>
                    <option>Where were you when you first heard about 9/11?</option>
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